A simple method for fashioning an antibiotic impregnated cemented rod for intramedullary placement in infected non-union of long bones

Bharti, Ajay; Saroj, Umesh Kumar; Kumar, Vineet; Kumar, Sanjay; Omar, Balram Ji

doi:10.1016/j.jcot.2016.08.004

Cited by 10 publications

(14 citation statements)

References 18 publications

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“…El tiempo promedio de mantenimiento del clavo fue de tres meses (rango [1][2][3][4][5][6][7][8][9][10][11][12][13]. No se observaron diferencias significativas entre la mediana del intervalo de días entre el primero y segundo tiempo quirúrgico comparando el desarrollo de SARM con el del resto de los gérmenes (48 días [RIC 45-75] vs. 73.5 días [RIC 56-149]; p = 0,2002 Mann-Whitney).…”

Section: Resultsunclassified

Clavo endomedular recubierto con antibiótico para controlar la infección en una seudoartrosis infectada de húmero. [Antibiotic cement rod to control infection in infected humerus nonunion]

Brandariz

Bennice

Boretto

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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Objetivo: Comunicar la eficacia del clavo endomedular recubierto con antibiótico (CERA) para erradicar la infección en la seudoartrosis infectada de húmero (SIH).Materiales y Métodos: Once pacientes (edad promedio 48 años). El tiempo entre la fractura y la cirugía fue 25 meses. El CERA se impregnó con vancomicina en 9 pacientes. El seguimiento promedio fue de 54 meses.Resultados: Se aisló S. aureus resistente a meticilina (SARM) en 5 pacientes. Todos recibieron antibióticos sistémicos por 7 semanas. El antibiótico más utilizado fue vancomicina. La mediana entre el primer tiempo quirúrgico y la reconstrucción fue 56 días (RIC 47-98). Luego del desbridamiento quirúrgico del primer tiempo, se midió el defecto óseo remanente y se lo dividió con variables dicotómicas: grupo con defectos <2 cm (7 pacientes) y grupo con defectos ≥2 cm (4 pacientes). No se observaron diferencias significativas entre la mediana de días entre el primero y segundo tiempo quirúrgico comparando el desarrollo de SARM con el de otros gérmenes (48 días [RIC 45-75] vs. 73,5 días [RIC 56-149], p = 0,2002 Mann-Whitney), ni en la proporción del tamaño del defecto óseo según el desarrollo de SARM o de otro germen (60% vs. 17%, p = 0,242 Fisher). Todos los cultivos fueron negativos y se logró la consolidación del foco fracturario, sin recurrencia de la infección.Conclusiones: El CERA es una buena opción terapéutica en el primer tiempo quirúrgico para un paciente con SIH. Se pudo controlar la infección, lo que permitió la reconstrucción secundaria de la seudoartrosis. AbstractObjetive: To evaluate the efficiency of the antibiotic cement rod (ACR) in the eradication of infection in infected humerusnonunion (IHN).Material and methods: We included 11 patients with IHN with a mean age of 48 years. The time between fracture-surgery was 25 months. The ACR was impregnated with vancomycin in 9 of de 11 cases. Follow-up was 54 months.Results: Methicillinresistant staphylococcus aureus (MRSA) was isolated in 5 of cases. All patients received antibiotics systemically for 7 weeks. Vancomycin was the most commonly used antibiotic. Time between ACR and reconstructive surgery averaged 56 days [confidence interval range (CIR) 47-98]. After debridement and implant removal, the residual space of the nonunion was measured with dichotomous variables and classified into two groups: group 1, < 2 cm (7 patients) and group 2, ≥2 cm (4 patients). No significant differences were observed between the number of days in which the ACR was placed and the development of the SAMR as compared to other germs [48 days (CIR 45-75) vs. 73 days (CIR 56-149) p= 0.2002 Mann Whitney]. Nor were differences observed in the size of the defect in those who developed MRS or any other germ (p=0.242 Fisher). Reconstruction was performed with different techniques. Laboratory parameters were normal, cultures were negative. Fractures could be consolidated without infection recurrence.Conclusions: ACR is a good treatment option for a patient with an INH. The infection could be controlled in all of the cases, which allowed the secondary reconstruction of the nonunion

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Section: Resultsunclassified

Clavo endomedular recubierto con antibiótico para controlar la infección en una seudoartrosis infectada de húmero. [Antibiotic cement rod to control infection in infected humerus nonunion]

Brandariz

Bennice

Boretto

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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“…The fracture site must simultaneously be protected using an external fixator or splint/cast. After the infection disappears, the nonunion is treated using a stable internal fixation 4 5 6 7 8) . The patient requires prolonged hospitalization between those two surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies reported treating patients with osteomyelitis using antibiotic cement-coated intramedullary nails 5 7 8 9 10) . However, this case shows an attempt to insert a tibial intramedullary nail in the femur.…”

Section: Discussionmentioning

confidence: 99%

“…Antibiotic cement-coated intramedullary nails maintain a locally high antibiotic concentration while maintaining bone stability. There have been reports about using K-wires with antibiotic-impregnated cements for femurs with narrow diameter 5) . Yet, it is uncertain whether this method can maintain stability when bearing weight, especially in patients with femur fractures and subtrochanteric area.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Proximal Femur Osteomyelitis Occurred after Proximal Femoral Nail Antirotation Fixation, with Antibiotic Cement-coated Tibia Intramedullary Nail: A Case Report

2018

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Antibiotic cement-coated intramedullary nails maintain a locally high antibiotic concentration while contributing to bone stability. We present a case of femoral subtrochanteric fracture in a patient with an infected nonunion who was successfully treated for an infection and nonunion using an antibiotic cement-coated tibial intramedullary nail. A 79-year-old woman with a right femoral subtrochanteric fracture underwent internal fixation using proximal femoral nail antirotation (PFNA). She developed osteomyelitis with nonunion at the surgical site 10 months postoperatively. We decided to insert an antibiotic cement-coated tibial intramedullary nail. After coating the nail with bone cement mixed with antibiotics, bone fixation was achieved by inserting the nail at the site of the PFNA. The patient's symptoms improved, symptoms from the infection disappeared, and bone union was confirmed. Osteomyelitis occurred because of postoperative infection following a proximal femoral fracture. Antibiotic cement-coated tibial intramedullary nails are an effective option to treat patients with osteomyelitis of the femur and achieve bone union where nonunion persists with shallow a intramedullary femoral canal.

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“…Uma vez que o antibiótico seja absorvido e tenha atuado no sítio infeccioso, o dispositivo residual de PMMA deve ser retirado em novo procedimento cirúrgico, pois pode servir de hospedeiro para contaminação secundária, e atuar como novo foco de manutenção da infecção. 15 20…”

Section: Antibióticos Por Aplicação Direta Na Ferida Operatóriaunclassified

Osteomielite crônica pós-operatória nos ossos longos – O que sabemos e como conduzir esse problema

et al. 2019

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Chronic postoperative osteomyelitis represents an important health problem due to its significant morbidity and low mortality rate. This pathology is challenging because of difficulties in understanding the pathogenesis and the decision-making involving the treatment. The present article had the goal of reviewing the definition, pathogenesis, clinical aspects, diagnosis, and treatment of chronic postoperative osteomyelitis, and of gathering this information in a single Brazilian updated publication.The PubMed, LILACS, and the Cochrane Library medical databases were analyzed using pertinent keywords. Current and relevant articles were selected.The present article gathered the established information, as well as innovations related to chronic osteomyelitis and its treatment, to offer updated data to assist the professionals involved in the management of chronic osteomyelitis.

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A simple method for fashioning an antibiotic impregnated cemented rod for intramedullary placement in infected non-union of long bones

Cited by 10 publications

References 18 publications

Clavo endomedular recubierto con antibiótico para controlar la infección en una seudoartrosis infectada de húmero. [Antibiotic cement rod to control infection in infected humerus nonunion]

Clavo endomedular recubierto con antibiótico para controlar la infección en una seudoartrosis infectada de húmero. [Antibiotic cement rod to control infection in infected humerus nonunion]

Treatment of Proximal Femur Osteomyelitis Occurred after Proximal Femoral Nail Antirotation Fixation, with Antibiotic Cement-coated Tibia Intramedullary Nail: A Case Report

Osteomielite crônica pós-operatória nos ossos longos – O que sabemos e como conduzir esse problema

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